It was Kim Dadou’s second day at New York’s Bedford Hills Correctional Facility. As part of the prison’s intake process, she was brought to the prison’s medical unit for a gynecological exam and pap smear.

“We were brought down three or five at a time,” she told Truthout. “It’s like an assembly line. They rush you in and rush you out. That in itself is degrading.”

To add to that feeling, the gynecologist did not explain what he was doing or why. “He didn’t talk to you except ‘Open your legs’ or ‘Scoot down,’” she recalled. As he examined her, however, he commented, “You have a very nice aroma.”

“I wanted to die,” Dadou said nearly 24 years later. “I was like, ‘This is prison? This is what I have to look forward to?’”

Nearly 5 percent of people who enter women’s jails and prisons are pregnant. While incarcerated, they face a host of challenges to safe and healthy pregnancies, including inadequate prenatal care, lack of food and vitamins, and, in many states, the threat of being shackled during childbirth, sometimes despite protective legislation.

But what about the 95 percent who are not pregnant? As Dadou’s experience demonstrates, women routinely face reproductive health care that is inadequate and dehumanizing. A recent report by the Correctional Association of New York, a criminal justice policy and advocacy organization, charged that “reproductive health care for women in New York State prisons is woefully substandard, with women routinely facing poor-quality care and assaults on their basic human dignity and reproductive rights.” But poor quality is not limited to New York – across the country, incarcerated women have reported “care” that ranges from ignored complaints to sexual violations during exams. In an egregious example of what passes for reproductive health “care” in prisons, several hundred people in California’s women’s prisons were coerced or tricked into some form of sterilization between 2006 and 2010.

Routine Gynecological Care: “These Experiences are Painful”

New York’s written prison policy dictates that women over age 30 be given annual gynecological exams, including a pap smear. “It may not always be exactly one year,” Dadou explained. “It may be 14 months or 16 months after your last gynecological appointment.” After more than a decade in prison, Dadou’s annual pap smear came back abnormal.

“Medical staff said it might be pre-cancer cells and that I needed to do a biopsy,” she recalled. The biopsy was performed inside the prison by staff who refused to explain the process. “I asked a lot of questions, and they looked at me like, ‘How dare you ask me what I’m doing or what’s happening next?’”

Dadou visited sick call nearly every day to find out the results. At first, she was told that the results hadn’t come back. When they did, the prison’s gynecologist was on vacation. “They told me I had to wait for the doctor to come back from vacation,” she remembered. After six weeks of worrying and daily visits to the sick call, she was able to see the doctor who told her that everything was fine.

Reproductive health-care practices are not uniform across the nation. Women entering the federal prison system, for example, are not given pap smears or gynecological exams. “You’re sitting in a small room with a computer,” is how Evie Litwok described the medical intake process. The medical officer asks about medical history, preexisting conditions and medications.

“You’re exhausted; you’re tired; you’ve been shackled all day; you want the cuffs off. You’re doing this at the end of a long day. But whatever goes into that computer is your life and your profile. Because you’re exhausted and chained, you don’t remember everything.”

In the federal prisons, Litwok explained, a call sheet is posted every afternoon. The sheet lists women’s assignments and appointments, including ones for routine mammograms and pap smears. Women can decline these exams, but they must do so at the appointment itself. “Most people choose not to get pap smears because these experiences are painful,” she said. “You want to deal with medical as little as possible because they hurt you.”

Litwok knows this firsthand. At the federal prison in Alderson, West Virginia, she was assigned an appointment for a routine pap smear. At the appointment, she said, the nurse shoved the speculum roughly into her vaginal canal. “I told her she was hurting me,” Litwok recalled. “She said, ‘No, I’m not.’” The nurse continued the process. “It went on for too long,” Litwok said.

She was never given the results of the pap smear. The next time she was signed up for a pap smear, she went to the appointment and declined.

When Care is Not Routine

In 2013, California made headlines when advocacy group JusticeNow and the Center for Investigative Reporting revealed that hundreds of women were sterilized. Some had been pressured into signing consent forms; others reported that the doctor recommended a hysterectomy without fully explaining its consequences. But this was not the first time the prison system’s reproductive health care had come under fire. In 1999, when asked why women were given pelvic exams for unrelated complaints such as stomach problems, the chief medical officer of Valley State Prison for Women told “Nightline” that the women deliberately wanted to be examined because the exams were the only male contact they received. Following the episode’s airing, he and another doctor were removed from their positions.

Over 12 years later, women at Valley State were having difficulty accessing reproductive health care. On December 19, 2012, shortly before California converted the prison into a men’s facility, Kelly Savage had her first medical exam since 2007. There, she told medical staff that, for the past several months, she had experienced pain and excessive bleeding, often bleeding for 12 days each month. She was given a pap smear. The results alarmed the prison’s doctor, who ordered an ultrasound the next day. The surgeon found a fibroid tumor, which he described to her as “cherry tomato-sized” and prescribed medication. Six days later, on December 26, Savage was transferred to the Central California Women’s Facility, another women’s prison across the street.

Savage, who also takes medications for migraines resulting from years of physical abuse, began feeling dizzy and passing out. After this had happened eleven times, medical staff recommended that she stop taking her medications. Savage refused, insisting that they contact the prison’s gynecologist, who recommended that she stop taking her migraine medication until he could examine her. “That was on a Thursday,” she recalled. “He couldn’t see me til the following week.” When he did, he changed her birth control medication; Savage stopped passing out.

Savage last saw the prison’s gynecologist in early March 2015. She was told that her tumor had shrunk and is now slightly bigger than the size of her fist. He also told her that, in the wake of increased scrutiny after the media and advocacy groups exposed the hundreds of coerced sterilizations within women’s prisons, the prison was reluctant to treat her. “He said they had too many lawsuits, so they might not be able to treat me,” she told Truthout. Although no lawsuits have actually been filed around the coerced sterilizations or reproductive health care in general, Savage said that she was told “that the lawsuits were causing their hands to be tied in terms of helping other people.”

Like those incarcerated in California, women incarcerated in Mississippi are not automatically given annual pap smears. In 2014, Amy Buckley, incarcerated in the Washington County Regional Correctional Facility, began experiencing pain and heavy bleeding. She requested a pap smear, then waited two to three weeks before being taken to the prison’s medical unit. In July, she was told that she had an abnormal pap smear. She was transferred to the Central Mississippi Correctional Facility, which imprisons men as well as women who are newly incarcerated, pregnant or ill.

Buckley did not see a doctor for over two months and then only after she had filed numerous requests and her family had made repeated phone calls to then-Commissioner Christopher Epps. When she did see the prison’s doctor, he told her he wanted another pap smear before approving further medical treatment off grounds. The date for her follow-up appointment came and went. She was not taken to see him.

Four months after her transfer, Buckley remained in pain. “In 24 hours, I go through 40 pads and a roll of tissue,” she described. “My period lasts 15 to 20 days. It’s not normal.” The prison’s nurse practitioner told her that she could not see an outside doctor until the prison compiled a medical history. In the meantime, he prescribed birth control for the pain and bleeding. The Mississippi Department of Corrections initially did not approve the prescription. When it did, Buckley reported that it had no effect.

“The pain I’ve been having in my ovaries has worsened and was so bad on Monday that I laid down and cried,” she wrote in early December, nearly five months after her transfer. “I’ve also been on my cycle since November 14 and it shows no sign of stopping.”

By the end of January 2015, six months after her transfer, Buckley was still in pain, and she reported that the clinic refused to see her. “I have put in three follow-up sick calls, but I still have not been called out,” she wrote.

The lack of timely care can have fatal consequences. In New York, “Sara” noticed a lump in her groin area. She signed up for sick call and waited a week to see a nurse practitioner. She then waited another week for an ultrasound and three more weeks for the results, which showed a fast-growing mass with blood circulation – a red flag for cancer. But Sara still had to wait three more weeks before she was given a biopsy and then another two before she was notified of the results, which showed an advanced tumor. Two more months elapsed before Sara was given surgery; the following month, she began chemotherapy and radiation. One year later, she told the Correctional Association’s Women in Prison Project that treatment had stopped, although two more lumps had appeared. According to Tamar Kraft-Stolar, the project’s director, one month before she was paroled, prison doctors told Sara that she had six months to live. She died five months after she was paroled.

“A Humiliating Problem”

But even accessing basic necessities like feminine hygiene products in prison can be a challenge. As reported previously in Truthout, Nicole Natschke reported that women in the segregation unit at Illinois’ Logan Correctional Center had to stage individual protests to receive sanitary pads. Their protests also came with a price – the women were issued misconduct tickets, which prevent an earlier release from segregation. “If we didn’t do that, we would’ve still been sitting on the toilet,” Natschke said.

In New York State prisons, women in general population are given 24 sanitary napkins each month. The pads are thin; one woman reported that she had to wear four pads at a time. Women can buy additional supplies at commissary, but for women earning 17 cents per hour (a common wage in New York prisons), paying 12 to 24 cents per tampon and 21 to 22 cents per pad is out of reach. Women who cannot afford these prices can apply for a special permit from the prison’s medical department, which requires a medical assessment.

Litwok recalls a scarcity of pads in the federal prison system as well. “If a woman runs out of pads, she has to go to the officer, who sometimes doesn’t have them,” she described. “Running out of pads happened every single day. It was worse on the weekends, when the warehouse to get supplies wasn’t open. Every day people were screaming at officers for pads, and the officers would be saying, ‘I can’t help you.’ That was a problem, and that was a humiliating problem.”

Kim Dadou still remembers her last visit to the gynecologist. The prison had scheduled her annual check-up. On that day, however, she had her period and asked the nurse to reschedule her. The nurse, who was known for being rude and disrespectful, refused to reschedule unless Dadou showed her the bloody pad or tampon string. If she didn’t, the nurse warned, she would be refusing medical care.

“My eyes welled up with burning tears,” Dadou recounted. “How humiliating.” She refused to show the nurse her tampon string and the nurse wrote that Dadou had refused medical care.

When Dadou tried to reschedule her appointment with the nurses at sick call, they initially refused, telling her that the nurse had documented her as refusing her previous appointment. Dadou persisted, however, and was finally given an appointment.

At the appointment, she partially undressed and climbed onto the exam table, which faced the door to the hallway. As the gynecologist was examining her, another staff member opened the door and, with the door still open, began a conversation with the doctor. “Here I was, exposed to anyone who walked by. I could see officers escorting women down the hall and other people passing,” she remembered. “Nobody turned their head to look in the doorway. That was the only blessing.”

That was the last gynecological care Dadou ever sought. Every year after that, she walked to the sick call station and signed a form refusing her annual appointment. Even after her release in 2008, Dadou has yet to see a gynecologist. “My experience in prison has traumatized me,” she said. “But I didn’t realize how traumatized I was until I thought about getting medical care out here.”

Reflecting on her experiences, Dadou states, “I don’t want any other woman to go through what I went through. I lived it and now I want it to change.”

This article was originally published by Truthout (www.truth-out.org) on March 27, 2015. Copyright, Truthout.org. Reprinted with permission.